Sameep S. Shetty

Oral cancer: Link with early coitus.

Sir, a 22-year-old mother presented to us, complaining of a sore area on the left side of her tongue, present for about two weeks. There was no other relevant medical history nor adverse oral habits. She had initially reported to a physician who suspected a local traumatic ulcer arising from an unerupted lower third molar. She was prescribed a topical steroid and chlorhexidine mouthwash. Reviewing the patient one week later with no signs of healing and progressive trismus and dysphagia, she was referred to us for further management. Extra oral examination revealed a tender, hard, enlarged right jugulodigastric and submandibular lymph nodes. Intraoral examination demonstrated a coated tongue, a tender, indurated erosive endophytic ulcer 2 × 3 cm We, as part of our micro-educational opportunities,2 engage with the community by sending our Year 5 dental students and hygiene/therapy students to a variety of community settings together with qualified dental nurses. These include a homeless shelter for young adults, a drug and alcohol detoxification unit, drug and alcohol recovery services, and the Probation Service (community drop in centres). The students talk with the residents and service users disseminating oral health advice, providing oral health screening and free toothbrushes and toothpaste. Patients requiring treatment are then offered an appointment at the Dental Academy where all treatment is provided by students free of charge through our NHS primary care contract. Although our provision of community service is much less comprehensive than that reported, as it is just one element of what we do at the Dental Academy, it does embed in the students a new dimension to their professional career. Despite reducing budgets, we have continued to provide the services due to their significant positive impact on the patients, as well as broadening the experience of our students. Last, we will point students to this excellent paper to give them greater insight into dental care for the homeless and hard to reach, to enhance their understanding in this important area of dental care provision. D. R. Radford, G. Potts, S. Dampier, L. Davda, Portsmouth

Facial Atrophy in Oral Submucous Fibrosis: An Association or a Coincidence

The anecdotal clinical presentation of OSMF that includes vesicle formation, burning sensation, intolerance to hot and spicy food, and trismus due to circumoral fibrous bands has been ringing in our ears for decades but the current paper flags novelty by portraying a rare presentation of an advanced stage of OSMF.

Comparison of surgical outcome after impacted third molar surgery using piezotome and a conventional rotary handpiece

Background and Aim: One of the most commonly performed surgical procedures by oral and maxillofacial surgeons all over the world is the removal of impacted teeth. The most critical and important steps in third molar extraction are bone cutting or osteotomy. Many techniques are used for this purpose including chisels and mallet, rotary instruments, and ultrasonic-based bone cutting instruments. Piezotome is newer and innovative device for osteotomy based on piezoelectric vibrations. Piezotome is considered very efficient in performing osteotomy because of its selective cutting; being inert against soft tissues, including nerves and blood vessels. The aim of this study was to compare the surgical outcome of third molar surgery using conventional handpiece and piezotome with all other criteria remaining same for all the individuals. Materials and Methods: All patients reporting to the Department of Oral and Maxillofacial surgery, Manipal College of Dental Sciences, Mangalore, for impacted mandibular third molar removal were screened. A total of 30 patients with same Pederson difficulty index for bilateral impacted third molar were selected for the study. The study involved the use of piezotome on one side (Side A) and rotary technique (Side B) on the other side for osteotomy on the same patient with an interval of 1 month. Therapeutic management was same for both the sides. Operating time was recorded in each surgery. Patients were examined postoperatively on 1st, 3rd, and 7th day and pain, edema, trismus, paresthesia, and dry socket were evaluated and compared on both the sides. Data collected were analyzed statistically. Results: The mean operating time was 48.13 min in piezotome (Side A) and 32.90 min in conventional handpiece (Side B) which was statistically significant (P < 0.001). Furthermore, there was statistically significant difference (P < 0.001) in the level of pain (P < 0.001), number of analgesics taken (P < 0.001), and trismus (P < 0.01) on 1st, 3rd, and 7th days postoperatively. There was no statistically significant difference in edema between the two sides. Paresthesia was present in one patient (3.3%) in Side B, while no paresthesia was present in Side A. No incidence of alveolar osteitis was reported on both the sides. Conclusion: Operating time with piezotome was more than that of conventional handpiece, but the postoperative responses such as pain, trismus, and edema were less in piezotome. Hence, despite being a slower procedure, piezotome can be an effective alternative for osteotomy in impacted third molar surgery. We recommend using piezotome for bone cutting and conventional rotary handpiece for tooth sectioning in order to obtain favorable outcomes as well as decreasing the operating time.

Pterygoid Hamular Bursitis: A Possible Link to Craniofacial Pain

A striking feature of the skull base is the pterygoid hamulus known for its bizarre morphology and biomechanical location. Pterygoid hamular bursitis is an inflammation of bursae located between the tendon, muscle, and bony prominences. The minimal objective finding in an apparently normal orofacial apparatus and dependence on the subjective symptoms experienced by the patient with widespread referral pattern often perplexes the clinician. Bursitis should be considered in the differential diagnosis of craniofacial neuralgia, temporomandibular joint dysfunction, and chronic craniofacial pain. Clinical signs and symptoms of this intriguing entity are diverse and multifaceted that can sometimes demand services of clinicians across various specialties considering the anatomic density of the region. Care must be taken to avoid delay, misdiagnosis, and overtreatment.

Mandibular Canal Widening and Bell’s Palsy: Sequelae of Perineural Invasion in Oral Cancer

Perineural invasion is an underrecognized route of metastatic spread along the nerve bundles within the nerve sheath into the surrounding tissues. It hinders the ability to establish local control as tumour cells can traverse along nerve tracts well beyond the extent of any local invasion rendering them inoperable and unresectable. Perineural invasion is a marker of poor prognosis. Oral submucous fibrosis with oral cancer constitutes a clinicopathologically distinct disease. Our case highlights an enigmatic presentation of oral submucous fibrosis and its coexistence with oral cancer presenting with unusual neurological disturbance of the inferior alveolar nerve and facial nerve and diffuse widening of the mandibular canal. The objective of this case report is to enumerate the significance of perineural invasion in determining the course of the disease and necessitate the need for future studies that can shed light on molecular mediators and pathogenesis of perineural spread.